By Ken Perrott 11/01/2017


Want to get up to date on  research about community water fluoridation (CWF) and the effects of fluoride in dental health in general?

fluoride-review-2Have a read of this new review. It’s published in a special issue of Community Dental Health devoted to the WHO approach to the prevention of dental caries through the use of fluoride. And is also deals with possible health effects of fluoridation and fluoride in general.

The Paper is: O’Mullane et al (2016). Fluoride and Oral Health. Community Dental Health 33, 69–99.

Summary and recommendations

The paper summarises the general conclusions and recommendations about CWF as follows:

1. Community water fluoridation is safe and cost-effective and should be introduced and maintained wherever socially acceptable and feasible.
2. The optimum fluoride concentration will normally be within the range 0.5-1.0 mg/L.
3. The technical operation of water-fluoridation systems should be monitored and recorded regularly.
4. Surveys of dental caries and enamel fluorosis should be conducted periodically. For effective surveillance the World Health Organization suggests that clinical oral health surveys should be conducted regularly every five to six years in the same community or setting.

Requirements for a CWF programme

But it is interesting to read its conclusions about the requirements for implementation of water fluoridation. This gives us an idea of why some areas do not fluoridate and what the technical and social requirements are for a successful CWF programme. These are the sort of things that district health boards will need to consider under the current legislations being considered by the New Zealand parliament.

Here is their list:

1. A prevalence of dental caries in the community that is high or moderate, or firm indications that the caries level is increasing.
2. Attainment by the country (or area of a country) of a moderate level of economic and technological development.
3. Availability of a municipal water supply reaching a large proportion of homes.
4. Evidence that people drink water from the municipal supply rather than water from individual wells, rainwater tanks or other sources.
5. Availability of the equipment needed in a treatment plant or pumping station.
6. Availability of a reliable supply of a fluoride-containing chemical of acceptable quality.
7. Availability of trained workers in the water treatment plant who are able to maintain the system and keep adequate records.
8. Availability of sufficient funding for initial installation and running costs.

fluoride and water

How many people have access to CWF internationally?

The review has an appendix providing data on worldwide totals for populations with artificially and naturally fluoridated water. This is very useful and anti-fluoride campaigners are well-known for misrepresenting this information in their attempts to claim that most countries reject CWF.

Here is the table for artificial CWF programs:

fluoirdation-world

It says in summary:

“The estimated worldwide total of people supplied with artificially fluoridated water as at April 2011 is 369,226,000 in 25 countries, including the United Kingdom, the United States, Canada, Brazil, Chile, Argentina, Peru, Panama, Guyana, Guatemala, Republic of Ireland, Spain, Serbia, Australia, New Zealand, Fiji, Malaysia, Singapore, Vietnam, Brunei, China (Special Administrative Region of Hong Kong), Papua New Guinea, Republic of Korea (South Korea), Israel and Libya.”

Natural fluoridation

The review also summarises data for people receiving fluoride through the natural levels of fluoride in their drinking water:

Natural fluoridation in the 25 countries operating artificial fluoridation schemes

“In the 25 countries with artificially fluoridated water there are an estimated 18,061,000 million people drinking naturally fluoridated water at or around the optimal level. That brings the total in these 25 countries consuming optimally fluoridated water to around 387,287,000 million.”

Other countries with natural fluoridation

“In addition, there are a further 27 countries with naturally fluoridated water supplied to an estimated 239,903,000 million people. However, it should be stressed that, in many instances, the naturally occurring fluoride level is in excess of the optimum – for example, in China, India, Argentina, Tanzania, Zambia and Zimbabwe. Total worldwide population drinking optimally fluoridated water.”

In summary – 437 million have access to fluoridated water

Combining data for artificial and natural fluoridation the review concludes:

“General estimates for the number of people around the world whose water supplies contain naturally fluoridated water at the optimum level for oral health are around 50 million. This means that, when the numbers of people with artificially (369.2 million) and naturally fluoridated water supplies (50 million) at the optimum level are added together, the total is around 437.2 million.”

Conclusion

This review is useful for anyone wanting an up-to-date picture of CWF, possible health effects and other issues.

I recommend that anyone active in the dental health area or who needs to respond to questions about fluoridation from the public have their own copy. they will refer to it again and again.

This link goes straight to the download of the pdf.